Three Maine health groups take new approach to Medicare patients

Three Maine health care organizations will participate in a new model designed to improve the health and lower the costs of Medicare patients, the U.S. Department of Health and Human Services announced Monday.

The three health systems have been approved as “accountable care organizations,” or groups of providers tasked with better coordinating each patient’s care. Seniors on Medicare will receive letters notifying them if their doctor is participating in one of the accountable care organizations.

The Department of Health and Human Services, the agency that oversees Medicare, the federal health insurance program for senior citizens, will track how well the accountable care organizations lower costs and improve care. Those that do both successfully will get a cut of the savings in the form of bonus payments, with the rest going to the federal government. Those that don’t, depending on their arrangement, will forgo the extra money or pay a penalty.

MaineHealth, parent to Maine Medical Center in Portland, opted for the less risky arrangement, according to Andrea Dodge Patstone, vice president of strategic initiatives. MaineHealth can earn back up to half of any savings it realizes, which is a lower percentage than the system could have netted, but also carries no risk of a financial penalty, she said.

“There’s no financial gain to be had unless you’re delivering on these quality measures that are so important to patient care,” she said.

Hospitals and physicians participating in accountable care organizations will be evaluated, for example, on whether diabetes patients were given proper preventive screenings and how many discharged patients wind up back in the hospital, she said.

The MaineHealth Accountable Care Organization will include about 35,000 Medicare patients who represent an estimated 16 percent, or $240 million, of the organization’s total patient revenues.

The accountable care organization model was formalized under the federal health reform law upheld in late June by the U.S. Supreme Court. Unlike the managed care model of the 1990s, accountable care organizations do not restrict which doctors or hospitals a patient may visit. Seniors also may opt out of sharing their health information with an accountable care organization.

The three Maine accountable care organizations were among 89 selected nationally to participate in the program for three years beginning July 1, according to a press release from the U.S. Department of Health and Human Services. Another group of about 30 accountable care organizations was announced in April.